| Doctor Name: | MRS. GWENDELON HAYDON DAVIS |
| NPI Number: | 1043360639 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | SW7677 |
| Business Practice Address: | 305 Kingsley Lake Dr Suite 702 St Augustine, FL - 320923045 |
| Business Phone Number: | 9047165619 |
| Business Fax Number: | |
| Mailing Address: | 1208 S Kyle Way, JACKSONVILLE |
| State: | FL |
| Postal Code: | 322591928 |
| Phone Number: | 9047165619 |
| Fax Number: | |
| NPI Enumeration Date: | 01/12/2007 |
| NPI Last Update Date: | 01/31/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | SW7677 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |